Washington, DC - TOP 10 CHANGES TO HEALTH INSURANCE REFORM BILL

1. REDUCES THE DEFICIT MORE—According to the CBO, the revised bill reduces the deficit by $30 billion over the first 10
years. (The original bill reduced the deficit by $6 billion over the first 10 years). The revised bill also continues to reduce
the deficit over the second 10 years.

2. ENDS HEALTH INSURANCE COMPANIES’ BLANKET EXEMPTION FROM ANTI-TRUST LAWS—In order to open up health
insurance markets to real competition, the revised bill ends insurers’ blanket exemption from anti-trust laws, bringing antitrust
enforcement to the two most abusive practices of health insurers – price fixing and market allocation.

3. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE—The revised bill
requires health plans to allow young people through age 26 to remain on their parents’ policy, at their parents’ choice.

4. CREATES A NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—The revised bill creates a long-term
care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become
functionally disabled. The measure provides a cash benefit to help individuals with community-based services.

5. EXEMPTS SMALL BUSINESSES WITH PAYROLLS BELOW $500,000 FROM EMPLOYER MANDATE—The revised bill exempts
a greater number of small businesses from the employer mandate – exempting 86% of all America’s businesses.
Specifically, the bill exempts firms with payrolls up to $500,000 (instead of $250,000) from the mandate and provides only a
graduated penalty for not offering coverage for firms with payrolls between $500,000 and $750,000 (instead of firms with
payrolls between $250,000 and $400,000.)

6. LIMITS THE “HEALTH CARE SURCHARGE” TO MILLIONAIRES—Under the revised bill, only the wealthiest 0.3% of
Americans would pay a surcharge on the portion of their income above $500,000 (instead of $280,000) for individuals and
$1 million (instead of $350,000) for couples, in order to help make health insurance affordable for middle class families.

7. ADDRESSING GEOGRAPHIC VARIATIONS IN MEDICARE PAYMENTS/MOVING TO MEDICARE PAYMENTS REWARDING
QUALITY AND COST-EFFECTIVENESS—The revised bill provides that the Institute of Medicine (IOM), through two studies,
will make recommendations on how to fix the current Medicare reimbursement system, including addressing current
geographic variations. Under the bill, the Centers for Medicare and Medicaid Services (CMS) will implement the IOM
recommendations on changes to Medicare payment systems unless disapproved by Congress.

8. BEGINS CLOSING THE MEDICARE PART D DONUT HOLE IMMEDIATELY—The revised bill moves forward the effective
date of reducing the donut hole by $500 and instituting a 50% discount for brand-name drugs in the donut hole, from
January 1, 2011 to January 1, 2010. It also completes elimination of the donut hole by 2019 (instead of 2024).

9. IMMEDIATE HELP FOR THE UNINSURED (INTERIM HIGH-RISK POOL)—To fill the gap before the Exchange is available, the
revised bill immediately creates an insurance program with financial assistance for those who have been uninsured for
several months or denied a policy because of pre-existing conditions.

10. HHS NEGOTIATION OF DRUG PRICES—Under the revised bill, the Secretary of HHS is required to negotiate drug prices
on behalf of Medicare beneficiaries.

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TOP 14 PROVISIONS THAT TAKE EFFECT IMMEDIATELY
1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE — Reduces the donut hole by $500 and institutes a 50%
discount on brand-name drugs, effective January 1, 2010.

2. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) — Creates a
temporary insurance program until the Exchange is available for individuals who have been uninsured for several
months or have been denied a policy because of pre-existing conditions.

3. BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage.

4. ENDS RESCISSIONS—Prohibits insurers from nullifying or rescinding a patient’s policy when they file a claim for
benefits, except in the case of fraud.

5. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE— Requires health
plans to allow young people through age 26 to remain on their parents’ insurance policy, at the parents’ choice.

6. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE—Eliminates co-payments for preventive
services and exempts preventive services from deductibles under the Medicare program.

7. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES—Improves the low-income protection programs in
Medicare to assure more individuals are able to access this vital help.

8. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE— Prohibits Medicare Advantage plans from
charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.

9. IMMEDIATE SUNSHINE ON PRICE GOUGING—Discourages excessive price increases by insurance companies through
review and disclosure of insurance rate increases.

10. CONTINUITY FOR DISPLACED WORKERS—Allows Americans to keep their COBRA coverage until the Exchange is in
place and they can access affordable coverage.

11. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance
program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

12. HELP FOR EARLY RETIREES—Creates a $10 billon fund to finance a temporary reinsurance program to help offset the
costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

13. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for a doubling of the
number of patients seen by the centers over the next 5 years.

14. INCREASING NUMBER OF PRIMARY CARE DOCTORS — Provides new investment in training programs to increase the
number of primary care doctors, nurses, and public health professionals.
PREPARED BY OFFICE OF SPEAKER PELOSI – OCTOBER 29, 2009

For more information on the just-introduced Affordable Healthcare for America Act, please visit:

http://docs.house.gov/rules/health/111_ahcaa.pdf